Burn therapy 1985: Acute management (original) (raw)

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Abstract

Mortality occurs from a burn injury because of infections which result from the metabolic and bacterial consequences of a large open wound, depression of the host's resistance, and both protein and total caloric malnutrition. Systemic antibiotics, topical wound therapy, and gentle wound debridement constitute traditional burn therapy. The systemic antibiotics and topical wound therapy do not solve problems presented by large open wounds and the related protein and caloric deprivation. A more rational approach uses antibiotics and topical wound therapy only as adjuncts to a program of early operative removal or excision of the devitalized, burned tissue and immediate closure of the wound. The excised wound is normally closed with available autograft, but in massive burn injuries, donor skin is insufficient. In these massive injuries, artifical skin can provide that immediate wound closure. As long as devitalized, burned tissue remains present in the setting of depressed host resistance, cross infection tends to colonize those remaining devitalized burn wounds with more virulent organisms than those that were already present. Bacterial controlled nursing units (BCNU) provide strict protection against that cross infection. Though inevitably a catabolic response occurs with massive injury, intensive nutritional support provides the calories necessary for the response to injury to avoid a prolongation of that negative nitrogen balance.

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References

  1. Burke JF, Bondoc CC, Quinby WC (1974) Primary burn excision and immediate grafting: a method of shortening illness. J Trauma 14:389–395
    Google Scholar
  2. Burke JF, May JW, Albright N, Quinby WC, Russell PS (1974) Temporary skin transplantation and immunosuppression for extensive burns. N Engl J Med 290:269–271
    Google Scholar
  3. Burke JF, Quinby WC, Bondoc CC, Cosimi AB, Russell PS, Szyfelbein SK (1975) Immunosuppression and temporary skin transplantation in the treatment of massive third degree burns. Ann Surg 182:183–197
    Google Scholar
  4. Burke JF, Yannas IV, Quinby WC, Bondoc CC, Jung WK (1981) Successful use of a physiological acceptable artificial skin in the treatment of extensive burn injury. Ann Surg 194:413–428
    Google Scholar
  5. Burke JF, Quinby WC, Bondoc CC, Sheehy EM, Moreno HC (1977) The contribution of a bacterially isolated environment to the prevention of infection in seriously burned patients. Ann Surg 186:377–387
    Google Scholar
  6. Burke JF, Wolfe RR, Mullany CJ, Mathews DE, Bier DM (1979) Glucose requirements following burn injury. Ann Surg 190:274–285
    Google Scholar
  7. Wolfe RR, Goodenough RD, Burke JF, Wolfe MH (1983) Response of protein and urea kinetics in burn patients to different levels of protein intake. Ann Surg 197:163–171
    Google Scholar
  8. Kien CL, Young VR, Rohrbaugh DK, Burke JF (1978) Whole-body protein synthesis and breakdown rates in children before and after reconstructive surgery of the skin. Metabolism 27:27–33
    Google Scholar
  9. Kien CL, Young VR, Rohrbaugh DK, Burke JF (1978) Increased rates of whole body protein synthesis and breakdown recovering from burns. Ann Surg 187:383–391
    Google Scholar
  10. Wolfe RR, Durkot MJ, Allsop JR, Burke JF (1979) Glucose metabolism in severely burned patients. Metabolism 28:1031–1039
    Google Scholar
  11. Burke JF (1982) Requirements for optimal glucose administration following injury. In: McConn R, ed.: Role of chemical mediators in the pathophysiology of acute illness and injury. New York: Raven Press, pp 355–360
    Google Scholar
  12. Glew RH, Moellering RC, Burke JF (1976) Gentamicin dosage in children with extensive burns. J Trauma 16:819–823
    Google Scholar

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Authors and Affiliations

  1. The Surgical Services of the Massachusetts General Hospital, Boston, Massachusetts, USA
    R. G. Tompkins & J. F. Burke
  2. Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
    R. G. Tompkins & J. F. Burke

Authors

  1. R. G. Tompkins
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  2. J. F. Burke
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Tompkins, R.G., Burke, J.F. Burn therapy 1985: Acute management.Intensive Care Med 12, 289–295 (1986). https://doi.org/10.1007/BF00261738

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